very CIO you talk to will say that, at least over the last four to five years, there has been no pause in their planning for future IT pur- chases. There has been no capability for us to

not be constantly upgrading, implementing or revising a project that is fairly major in scope. Even without Meaningful Use, and then ICD-10, most organizations are working on major implementations day to day. They may not be thrashing about in a bad way, but they are coping with valuable manpower, time and budgetary resources being strained for large stretches of time. For example, at Seattle Children’s Hospital, we have been on a constant electronic medical record (EMR) upgrade path. We have been preparing for ICD-10 for two years. The pace is constant, and one of the biggest issues we have dealt with is in determining the rate of change that our staff can absorb, as well as how the steps we make today will impact the steps we may need to make in the future.

While I cannot speak for every CIO, I think it is safe to say that most of us don’t look at IT purchasing as an action unto itself. On a macro level, it is a lengthy pro- cess of examining a chain of processes and listening to many people throughout our organization. On a more micro level, we look at requirements, then we look at what software, hardware or whatever other component is needed to meet those requirements. After these wide and narrow perspectives are drawn, only then do we look at purchasing. This complicated practice, one that CIOs engage in on a daily basis, is just one of the very real issues that are too often ignored by IT vendors today. I am an ex-Air Force guy, so I like to think in terms of flight plans. At Seattle Children’s, we have flight plans for all our major applications. These plans describe how, where and when we bring in any new modules, and how they will fit with both legacy and future modules. They also outline our expectations relative to our staff in terms of any training or technical support they will need moving forward. Our flight plans are not designed by just our IT staff. We have a clinical advisory panel, and they dictate the

sequence and the level of attention required for any given module as it comes online. Like all projects requiring money, the business side of our organization provides input in our decision-making as well. We believe IT planning by every stakeholder in the organization is vital because we understand, sometimes from hard lessons in the past, that many people are going to be impacted today, and in the future, by the new IT purchases we make and implement. If I could speak directly to a vendor, I would say, “Give me a flight plan. How and when will your module help us down the road? Who on our staff will be impacted today and later on by your module? What flexibility or limitations will we experience moving forward when making future IT purchases with you or another vendor?” CIOs do not want to buy a module to solve just a

current issue. Our purchases are a major investment, and vendors need to demonstrate a clear and valuable return on our investment. What our staff at Seattle Children’s finds attractive is a solution that will scratch our itch right now coupled with a road map, or flight plan, for its functionality in the future. There are a couple of vendors in the market taking this

forward-thinking approach today. A sterling example is ServiceNow. They are the ERP, or the EMR, for IT folks. They are a good example of a software vendor telling the market, “Yeah, we can provide software ticketing, but look. We have these other modules that you can add to help you work with problems, change, your configuration management database, workflow, account provisioning and so on and so forth. We’ll scratch your ticketing itch right now, but what’s really exciting about our product is here are all these other things that you can do with it in the future.” I envision more IT vendors will take the time to design and incorporate flight plans with their solutions like ServiceNow. Quite frankly, if they don’t, I think they will have major problems in the future securing customers in healthcare. For that matter, they’ll have problems finding custom- ers in any field of business, period.